Hospices Put On Life Support

June 1, 2008 Michele Donohue

Hospices care for people at their most vulnerable time, but now those services are at risk as 3,000 Medicare-licensed hospices face slashed reimbursements in President Bush’s 2009 budget proposal.

"If these cuts do happen, we’re going to have to look at the community. We don’t want patient care to suffer," said Patricia Morgan, Hospice Southeastern Connecticut’s community development director, based in Norwich, Conn.

The budget proposal seeks to eliminate the hospice market basket for three years and reduce the update in the following two years by 0.65 percent, affecting the Medicare Hospice benefit reimbursement by more than $5 billion in five years. Another rule that would change, which does not require Congressional approval, is the technical way market basket rates are read, additionally impacting reimbursement by more than $2 billion. The regulations would also increase the time between on-site surveys, from its current six to eight years to 10 to 12 years.

Hospice reimbursement cuts would hinder quality end-of-life care that saves the Medicare system more than $2,300 per patient in the last year of life, according to a Duke University study published in Social Science & Medicine, and come when hospices expect more patients as the Baby Boomers age.

Almost every hospice in the country would be affected by the cuts. Some groups would take a 15 to 16 percent reimbursement reduction, depending on organization and location, according to Jonathan Keyserling, public policy and council vice president of the National Hospice and Palliative Care Organization (NHPCO) in Alexandria, Va.

"We have and continue to have conversations with supporters, urging them to take a more rational approach to meeting the needs of those providing services to the dying in this country," said Keyserling. NHPCO estimated that 1.3 million people used hospice services during 2006 and the Medicare Hospice benefit covered more than 80 percent of patients.

"It will definitely put a strain on all hospice programs. We’ll have to do more fundraising," said Morgan. Hospice Southeastern Connecticut organizes an annual walk and recently added an online donation button to its Web site.

"We, like everyone else, are keeping a close eye on it and being proactive in our planning," said Elizabeth Macomber, vice president of philanthropy at Danvers, Mass.-based Hospice of the North Shore.

Memorial donations make up "a significant portion of gifts received overall" to hospices, said Christine Stockley, development director for Attleboro, Mass.-based Community VNA. "Many people will give an immediate gift. For on-going support you need to make the case of why this organization needs to be supported on an on-going basis," she said.

Some hospice providers said that having an inpatient facility increases community visibility compared to a visiting nurse program, thus making it easier to fundraise. But in 2007, only 19 percent of hospice programs had their own facility, according to the NHPCO.

"It certainly brings an identifiable product to people. It’s something they can touch, feel, see," said Macomber. The Hospice of the North Shore’s Kaplan Family Hospice House, a facility with 12 patient suites, offers naming recognition and a garden brick remembrance program. "The hospice house helps the public become more understanding and made it more real to them."

A hospice facility lends itself to recognition programs that entice prospective donors, such naming opportunities for rooms and equipment.

"Hospices that do not have a hospice house have nothing to really show off," said Arleen Ellis, philanthropy director at Hospice & Palliative Care of Cape Cod in Hyannis, Mass. The hospice offers a 10-bed short-term residence facility, which Ellis explained, can help attract donors. "We can bridge the gap between hospitals and hospice a little better with that because we have something solid and perceivable. You can’t take a prospective donor into a patient’s home or even a nursing home. It’s not realistic."

Three out of four hospice patients die in a "home" setting, either in private residences, nursing homes or residential facilities, according to NHPCO. Nurses travel to provide patient care and services, and most hospice officials said the majority of donations are from appreciative families naming hospices in memorial donations.

Ellis said that her organization usually sends a general information brochure about the hospice with tax-exemption acknowledgement letters to introduce first-time memorial donors to the organization, mostly friends and family that honor donation requests in obituaries.

The annual appeal from MaineGeneral Health, based in Augusta, often includes a patient’s story with the family’s permission, according to Development Assistant Linda Allen, who said, "the work speaks for itself."

Macomber said Hospice of the North Shore keeps donors regularly updated about events with newsletters and regular correspondence. Ellis said it’s hard to gauge mail appeals, but families usually want to "express their gratitude for the hospice or memorialize their loved one."

The Hospice of Martha’s Vineyard, in Massachusetts, has relied on community funds instead of Medicare reimbursement to maintain its free services since it opened in 1981.

"I’ve heard many people say, ‘I want you to be there when it’s my turn.’ And they know they are supporting an organization that was there for their neighbors and loved ones and hope, when it’s their time, them," said Terre Young, Martha’s Vineyard hospice executive director.

The Martha’s Vineyard hospice runs various events during the year to raise money, including a summer dinner soiree, handmade Christmas sale and a 5K race. Services and goods donated or sold to the group at reduce cost by community members.

And even though Medicare cuts will not affect the hospice, the economic crunch has forced the organization to send out its annual appeal in the two local newspapers and their newsletter — making it the first time the group had to try all three outlets at once.

"Money is less free than it used to be and there is more competition for the dollar," said Young. NPT